Since the Republican’s massive victory in November President Obama has been setting up strategy to blame Republicans for all that will go wrong as that majority pledged they would repeal Obamacare.

It was strange that President Obama was not contrite or acted defeated by the election. He said 66% of the people did not vote. He said that those 66% did agreed with his policies and therefore it was a mandate for him to carry on.

President Obama knows he has the RINO’s on their heels

The traditional mainstream media did not question President Obama’s premise that 66% liked his policies.

Another explanation could be that those 66% disagree with President Obama’s policies. They believe in President Obama but believe his policies are wrong and did not vote for them.

After all, President Obama said the election was about his policies.

He has not paid attention to needs or will of the Americans people.

President Obama has used the traditional mainstream media (TMM) to promote his agenda. After the TMM publishes the Obama administration’s lies over and over again it becomes the truth even though it remains a lie.

A perfect current example is the administration’s lie that open enrollment for Obamacare is going great.

‘The Republican moves come, ironically, as the Affordable Care Act is working fairly well. The three-month enrollment season for 2015 is going smoothly and will likely surpass the administration’s modest second year goals of having 9 million covered in exchange plans.’

After two years of open enrollment if Obamacare signs up the original estimate of 13 million, it still has 320 million people short. However, President Obama will tout the amazing success ever though Obamacare is unsuccessful and harmful to Americans who were satisfied with their insurance and their doctor before Obamacare.

President Obama has been collecting increased taxes for Obamacare for 4 years.

I believe Republicans should be aggressive. They should lay out a business model that will work immediately. Then repeal Obamacare . Let the President veto the bill as Republican actively work to replace Obamacare with a carefully explained alternative that makes sense to the public. Republicans can then try to overturn the Presidents veto.

President Obama has asked Republicans over and over again to give him some ideas to fix Obamacare. Obamacare cannot be fixed because of President Obama’s ideology. It must be repealed.

Republicans have many ideas to replace Obamacare with. For years they’ve discussed tax credits to buy insurance, high-risk insurance pools that work and allowing insurance to be sold across state lines. They need to put these ideas together with a compelling and viable business plan such as my ideal medical savings account.

Republicans must create a consumer driven healthcare system.

President Obama and the media have mocked Republicans for not having a plan or offering a fix for Obamacare. I said previous there is not fix for Obamacare. The American public does not want their freedoms restricted. In addition a single party payer system have failed economically in all of the developed countries except Switzerland.

A plan must include an entirely new system that includes a business plan. The plan must include the freedom for consumers of healthcare to choose and provide access to care without rationing of care.

The plan must also include systems of care for the most expensive chronic diseases such as Diabetes, Asthma, Cancer and Chronic Infectious Diseases.

The plan must not exclude access of care for the elderly that need hip replacements, knee replacements, cancer treatment or heart disease.

The plan must develop a system for decreasing the cost of the treatment of chronic diseases. It must have within the treatment system a plan to make the consumers more responsible for the health and healthcare dollars.

It should shift the responsibility of care from the government and insurance companies to consumers. Consumers should decide what they need not the government.

Republicans have had six years to decide on what they should be promoting.

President Obama is in a perfect position to mock and veto any Republican piecemeal suggestion.

President Obama has already smiled regarding the new Republican majorities when he said he has to sharpen his veto pencil implying all they will do is present bills that are stupid.

However, the Republican leadership, rather than passing bills in the senate and house of representative to repeal Obamacare, have chosen to work with the Democrats and President Obama.

The Harvard faculty uproar of the last few days is very important. Almost all the faulty were big supporters of Obamacare until it affected them. I hope the rest of the country reacts the same way and demands their local newspapers publish multiple stories about their citizens pain.

The dice have been loaded against the American people by the rules and regulations in Medicare and Obamacare.

Patients liked their doctors. Once they discovered that they could not keep their doctors under Obamacare they became angry at President Obama for lying to them. The soon to be released new payment rules will increase the anger.

These complexities are in effect ending independent medical practices. This has been intentional. The Obama administration doesn’t want to control 600,000 independent physicians. It wants to deal with the hospital systems the are involved with. The hospital systems can then deal with the doctors.

Republicans are looking for a compelling alternative to Obamacare.

Just as Obamacare was forced through congress, President Obama is trying to force how medicine is practiced in America down the throats of Americans.

It is consistent with Jonathan Gruber’s view that Americans are to stupid to understand what is going on. It follows that Americans are too stupid to be responsible for their own care.

Americans want freedom of choice. They do not want the government to tell them what to do.

Physicians by nature and education are competitive. Competition leads to improvement of the delivery of medical care.

All medicine is local. The alternative to Obamacare is to have local completion among physicians and permit patients to choose their doctors.

The answer to the Republican’s dilemma is right in front of their eyes.

A real Republican alternative to Obamacare would support physician ownership of independent medical practices and preserve local competition between doctors and maintain choice for patients.

Obamacare’s promotion of large hospital systems with salaried physicians eliminates physicians competing for patients. The lack of physicians competing for patients destroys the physician/patient relationship.

Physicians listen to patients if patients have a choice. The interaction is a partnership called the patient /physician relationship.

This solves the problem of President Obama’s lie. “If you like your doctor you can keep your doctor period.” Patients choose their doctors.

Dr. Donald Berwick and Jonathan Gruber’s view the consolidation of physicians and hospital systems as a necessary step to enable payment liability onto providers through hospital systems and away from government programs such as Medicare and Obamacare.

President Obama does not understand that doctors are not stupid either. At the moment physicians feel financially cornered by the government and the hospital systems and are joining hospital systems as a temporary means of surviving.

President Obama also does not realize that over the last 50 years there has been a build up of physician distrust for most hospital administrations.

Most administrators have tried to repair that mistrust but it has not been very successful. Hospital systems have been trying for years to own their physicians’ intellectual property and surgical skills for their hospital system’s profit. It is all about economics. Patient care is secondary.

As hospital systems consolidate competition will be eliminated. Then hospital systems will realize they are losing money because of the risk they agreed to accept from the government. Hospital systems will demand more money from the government or consumers or go out of business.

Who loses?

Patients lose, taxpayers lose, and the American healthcare system loses.

The abuses of the healthcare system by all the stakeholders must be fixed. It will never be fixed by forcing stakeholders to fix it. It will only be fixed by aligning incentives of all the stakeholders. Consumers must lead the way.

It has also been reported that hospital systems are complaining that they are losing money on their physicians in these integrated systems.

Hospital systems are dropping out of the Obamacare Accountable Care Organization programs. There have been reports that salaried physicians are less productive that independent practicing physicians.

I believe in the team approach to the management of chronic disease. The patient must be at the center of the team with the physician being the head coach or manager and his team being an extension of the physician’s care.

Medical decision making entities must not be the insurance company or the government.

The idea that integrated systems with salaried physicians leads to increased economic efficiency, better quality of care and clinical outcomes than small independent private practices never made syllogistic sense to me.

Patient care becomes depersonalized in large hospital systems. Both patients and physicians become commodities in systems focused on the bottom line.

Small practices have the advantage of providing a personal style of care. Consumers want that comfort when they are sick. They want someone they know who is going to listen to them and talk to them.

In a private setting physicians can practice the way they want, without interference by a large, impersonal organization driving efficiency.

If a physician in private practice does not satisfy the consumer’s need the consumer can leave the practice and go somewhere else.

"When you work closely with patients and empower them, they are going to make better choices," said Craig C. Koniver, MD, a solo family physician in North Charleston, South Carolina. He said a team of caregivers at a large practice will not have the same impact, because none of them are as close to the patient as he is.”

Health Affairs published a study in August 2014 looking at primary care physicians in small practices and “ambulatory care sensitive” admission rates. The study included such conditions as congestive heart failure in which admission to the hospital can be preventive by high quality primary care. The patient relates positively to the physician and the physician relates positively to the patient (positive patient/physician relationship).

“The study found that practices with 1 to 2 physicians had ambulatory care-sensitive admission rates fully 33% lower than practices with 10 to 19 physicians.”

This is not the only study that shows that small independent private practices can deliver just as high or higher quality of care than large integrated hospital systems with salaried physicans.

“ A 2013 study[2]showed that small practices in general had slightly lower hospital readmission rates than large practices.”

Additionally, “a 2012 study[3]looking at practices ranging from 5 to 750 physicians found that the smaller ones had fewer ambulatory care-sensitive admissions and lower overall costs of care for diabetes.”

All three studies turned a piece of conventional wisdom on its head; that large practices, with their care management teams and sophisticated clinical information systems, produce better clinical outcomes.

Republicans should start presenting alternatives to Obamacare. The alternative must provide consumers with what they want rather than systems that let the government to tell consumers what they are going to get.

This is a message for the Republican majorities in the House and Senate. Obamacare is a disaster built on a failed ideology, deceptions and lies.

Obamacare started off with lies and continues to deceive the American public.

Its emotional seductions have also deceived many physicians.

All one has to remember is Jonathan Gruber’s statement about the lack of transparency being a powerful political tool. Gruber said given the lack of transparency, the public is too stupid to figure out the truth.

President Obama told us; ”If you like your doctor you can keep you doctor, period.”

This statement was not true for an instant. President Obama knew it but ideology trumps reality. Many have blamed Obamacare’s failure on President Obama’s inexperience as a manager. This is not the reason.

The failed progressive ideology of big government controlling choices and freedoms of the American people is the reason for Obamacare’s failure.

Last week, Senator Charles Schumer (D-N.Y.) admitted the passage of Obamacare was a mistake. Not surprisingly, the mainstream traditional media has not mentioned Schumer’s admission.

The mainstream media has been a shill for Democrats and President Obama. It has helped the Obama administration keep the truth from the American public.

President Obama keeps the American public uninformed with the help from the traditional mainstream media. His goal is central government control of Americans’ choices and freedoms. President Obama’s support is derived from his appeal to Americans’ emotions and not from the facts.

His problem is Americans are not stupid. They can separate reality from appearance when they pay attention. Obamacare is now affecting them directly and they are paying attention.

As a result of Obamacare deductibles have increased beyond affordability. Consumers cannot afford to utilize their “healthcare insurance” until absolutely necessary. The result will be higher costs when patients are forced to use the insurance because of the development of complications from a chronic disease.

In 2008, pre Obamacare, the US had seen a drift downward in health-care spending.

The downward trend began to reverse as Obamacare first officially launched in October 2013. In the fourth quarter of 2013, health-care spending rose 5.6 percent, far above the 2.6 percent growth rate of the economy, to which it significantly contributed.

“The rapid increase in spending does not indicate that the system is working to lower costs, an absurd if not Orwellian construct by President Obama.

“Nor is the debate “over,” no matter how many times Obama claims otherwise. Too bad the White House chose not to take advice from National Journal’s Ron Fournier.

“The president risks insulting a vast majority of Americans by dismissing their concerns with a consultant's talking point,” Fournier wrote before the economic figures were released, “and Obama can't afford any more blows to his credibility.”

Consumers are tired of President Obama’s lies. He has lost all credibility with the American public.

The Obama administration keeps telling us how well Obamacare’s Accountable Care Organizations are doing. The Obama administration keeps saying hospital systems must set up integrated healthcare systems (ACOs) to increase the quality of care.

President Obama refuses to believe that even though the ACO model sounds great its successful execution is difficult to impossible.

The chances for ACOs to succeed is not only dependent on the hospital system’s ability to decrease utilization, it is heavily dependent on patients taking responsibility for their own care. Patients must follow instructions.

President Obama believes he can lie his way out of reality. The American public is not buying these lies any more.

Republicans must focus on the reasons for the obvious failures of Obamacare.

Consumers want to have freedom of choice. They do not want the government to control them.

Republican must focus on creating programs to provide incentives for consumers to be in control and responsible for their health and healthcare dollars.

Republican must focus on ways to permit consumers “to keep their doctors if they like their doctors period.”

The mid-term elections are over. The Republicans captured majorities in the House and Senate. The election was a clear repudiation by the people of President Obama’s policies.

President Obama has denied this reality. He has pledged to pursue his ideological goals that have hobbled the people and the country so badly.

The polls have indicated that the public is opposed to Obamacare and all of its unintended consequences.

We ain’t seen nothin yet. The unintended consequences are going to escalate starting with the delayed open enrollment season on November 15 2014. This opened enrollment was unnoticed, so Democrats did not suffer any blowback from Obamacare during the mid-term elections.

Larger categories of people and businesses will be affected by Obamacare’s rules and regulations on January 1,2015. Last year only people in the individual healthcare insurance market were affected.

President Obama continues to mock Republicans by telling them he will be happy to listen to them to see if they have a better idea than Obamacare.

Everyone knows he has no interest in changing or repealing his legacy healthcare law.

The majority of people are dissatisfied with Obamacare. All the Republicans have to do is come up with an idea that is compelling to all of the public. The power of public opinion can demand that Obamacare must change.

It has to be a simple idea. It has to teach consumers how to be responsible for their health and their own healthcare dollars. It has to educate consumers on how to drive the healthcare system and remove government from controlling their healthcare choices.

The basic problem with our present healthcare system is medical care is fragmented. In addition, all the stakeholders’ vested interests are misaligned.

President Obama, with his forced passage of Obamacare, has added to the dysfunction of the healthcare system. .

Obamacare is meant to be a step toward a single party system.

The government cannot afford, and the nation will not accept, a government controlled single party payer system.

Obamacare does not do anything to repair the distortions of to the system that have led to the dysfunction of the healthcare system pre Obamacare.

The most important stakeholder in the healthcare system is the consumer. Obamacare has marginalized consumers/patients even further.

It was hard for consumers to have notice the dysfunction in the healthcare system because only 20% of consumers use the healthcare system at one time. The remaining 80% thought their healthcare insurance was fine.

Since Obamacare was passed into law it is affecting everyone directly and they are starting to complain.

The current state problem are shown in the figure below.

A dizzying array of stakeholders is all fighting for a competitive advantage, or at the very least survival, in the dysfunctional current state.

Obamacare’s rules and regulations have made the current state more difficult for everyone. This is leading to the impending collapse of the healthcare system.

Republican Party should not tinker with legislation to try to fix Obamacare.

It should step in right now and educate the consumers about their consumer power. Republicans need to present a market driven solution that is easy to understand.

Once the public understands what they can do, it will change its attitude from the helplessness and hopelessness to an empowered reaction to do something to change the system.

There are many other things that need to be demanded by the public. I believe empowering the public to demand a market driven system is crucial to a viable and affordable healthcare system.

Almost all the stakeholders believe something must change. The centrally controlled healthcare system’s business model will not work or be sustainable. All one has to do it look at the VA Health System.

Consumers and businesses are becoming frightened and beg the government for help. The government will institute a single party payer system.

The result is that consumers will not be able or willing to tolerate a centrally controlled healthcare system.

As I see it, the nation has two choices: Alternative 1 and Alternative 2.

Alternative 1:

If we extend the course of our present healthcare system to a single party payer system (Alternative 1) the costs will escalate, and access to care will decrease. It is inevitable the rationing of care will occur.

Provider systems and administrative systems would have incentive to make its products attractive to consumers at the lowest price possible with the highest quality of care.

Consumers, by owning their healthcare dollars, would have the freedom and resources to choose. Government and its bloated and inefficient bureaucracies should not be making medical care choices for consumers.

Two things must happen. Republicans must teach consumers the advantages of a market based business model.

The Republican congressional majority must start teaching all the other stakeholders (physicians, hospital systems, the government, the healthcare insurance industry and Big Pharma) the advantages of this market-based system to their vested interest.

The alignment of vested interests must start right now and not down the line.

The Obama administration will dismiss the possibility of a successful market based system. Republicans must not be intimidated. Didn’t they win the election this time?

The Obama administration’s conclusions are based on ideology not past history, logic, fact or evidence.

The Obama administration and its followers will reject the possibility of success for an incentive driven system instead of a government controlled system.

“Why don’t more physicians protest? Why don’t they describe their problems in the age of Obamacare?”

There are complex reasons that there has not been an organized physician outcry.

Organized medicine (AMA) and other organizations representing specialties in medicine and surgery are afraid to lead an outcry. Their main goal is to not lose their seat at the table.

This is strange goal. Politicians and their health policy advisers have ignored organized medicine for the last 50 years. Many smart physicians in or out of these organizations have tried to have their voice heard but have failed.

Since Medicare was passed (the last 50 years) there have been many outrageous changes proposed by non-physicians The healthcare policy changes were proposed to decrease the increasing cost of healthcare. Instead these changes have increased the cost of care.

The politicians and healthcare policy advisers are always changing the wrong policies. They are always putting more power into the government bureaucrats and healthcare industry’s hands rather that putting power into the patients’ hands.

Physicians who have seen these policy changes work out for their benefit are hesitant to participate in an Obamacare protest. These physicians assume Obamacare will also work out well for them

However, physicians do not realize that their intellectual property and surgical skills have been devalued with each of the present changes in healthcare policy.

In a 2006 blog I described how to cook a frog without the frog jumping out of the pot water. Everyone knows that you increase the temperature of the water one degree at a time. When the frog realizes what is going on he is too weak to jump out.

Obamacare has increased the temperature of the water to an intolerable level. At present few frogs have the energy to jump out of the water.

Most of the changes in Obamacare are going hurt patients by decreasing access to care and rationing of care. The physician/patient relationship has also been destroyed.

Dr. Mark Sklar, a Clinical Endocrinologist in Washington D.C., had enough energy to jump out of the hot water. He launched his protest in an excellent article and got the attention of the editors of the WJS.

My hope is Dr. Sklar’s article will launch a consumer protest demanding that a change be made from Obamacare to a healthcare system that will empower consumers.

The new healthcare system should be a consumer driven healthcare system that puts consumers in control of their health and healthcare dollars. The control of the healthcare system should not be in the government’s or the healthcare insurance industry’s hands.

A consumer driven healthcare system should provide incentives to consumers to remain healthy, and provide financial reward if they do. It should also make shopper of consumers.

A consumer driven healthcare system will drive the other stakeholders into a competitive mode to vie for the business of the consumer.

The financial reward should be for consumers, not to the healthcare insurance industry, government, hospital systems or physicians.

I want to echo Dr. Sklar’s protest. I will try to help Dr. Sklar make his article a wake up call for consumers.

Consumers are the only stakeholders that can turn the destruction of the medical system around.

Consumers elect politicians. Politicians like the advantages and perks they receive from their elected positions. Politicians are afraid of the consumers that vote to reelect politicians. They will comply with their voters demands.

Below is Dr. Sklar’s article listing most of the issues that are making the delivery of healthcare very difficult.

"Endlessly entering data or calling for permission to prescribe or trying to avoid Medicare penalties—when should I see patients?

‘It has been four years since the passage of the Affordable Care Act, so I thought it may be useful to provide the perspective of a physician providing daily medical care. I am an endocrinologist in Washington, D.C., and have been in solo private practice for 17 years after seven years at an academic institution. Since 1990, the practice of medicine has changed significantly, seldom for the better.

In the 1990s insurance companies developed managed-care plans that greatly increased their profits at the expense of the physician. With the Affordable Care Act, we are seeing new groups profiting from changes to the health-care system. Entrepreneurs and hospital executives are capitalizing on organizing physicians into groups called Accountable Care Organizations from which they will take a very substantial percentage of collected income. Now that physicians are being required to use electronic medical records, the companies that develop them are harvesting money from physicians' practices and from hospitals.

The push to use electronic medical records has had more than financial costs. Although it is convenient to have patient records accessible on the Internet, the data processing involved has been extremely time consuming—a sentiment echoed by most of my colleagues. To save time, I was advised by a consultant to enter data into the electronic record during the office visit. When I tried this I found that typing in the data was disruptive to the patient visit. My eyes were focused on the keyboard and the lack of direct contact kept patients from opening up and discussing their medical and personal problems. I soon returned to my old method of dictating notes and pasting a print-out of the dictation into the electronic record.

David Klein

Barrier between Patient and Physician

Yet to avoid future financial penalties from Medicare, I must demonstrate "meaningful use" of the electronic record. This involves documenting that I covered a checklist of items during the office visit, so I spend 90 minutes each day entering mostly meaningless data. This is time better spent calling patients to answer questions or keeping updated with the medical literature.

If electronic records ever allow physicians to obtain data from previous laboratory and imaging testing, it will improve costs and patient care. So far, however, the data in electronic records—like paper charts—can't be shared unless physicians work in the same health-care system.

My practice quickly adopted the new Medicare requirements for electronically prescribing medications. Yet patients often do not want their prescription sent electronically. They want a physical copy—either because they don't trust the Internet or because they don't need to fill the prescription immediately. If I don't electronically prescribe for a certain number of Medicare patients, I am penalized with a decrease in reimbursement that can rise to a maximum of 5%. Patients should have a choice in how their prescriptions are delivered, and physicians shouldn't be penalized for how the patients choose.

To prevent physicians from prescribing more costly medications and tests on patients, insurers are increasingly requiring physicians to obtain pre-authorizations. This involves calling a telephone number, often being rerouted several times and then waiting on hold for a representative. The process is demeaning and can take 30-45 minutes. Rather than having physicians pre-authorize expensive medications, the outrageous costs of many non-generic medications must be addressed. I understand that pharmaceutical companies need to make profits to cover investments in drug development. However, they should have some compassion for their customers.

To avoid Medicare penalties, I also must participate in the Physician Quality Reporting System program. Initially, this involved choosing three codes during the patient visit to reflect quality of care, such as blood pressure or blood-sugar control, and reporting them to Medicare. In 2015, the requirement will increase to nine codes.

Coming down the pike, but thankfully postponed from the October 2014 deadline, is something called ICD-10. This is a newer system that will contain about 70,000 medical diagnostic codes used for billing insurance. The present ICD-9 system has about 15,000 codes. The Physician Quality Reporting System and ICD-10 requirements are intended to benefit population research, but the effect is to turn physicians into adjuncts of the Census Bureau who spend time searching for codes—and to further decrease the amount of direct contact with patients.

The practice of medicine in the current environment is unsustainable. The multiple bureaucratic distractions in my day consume so much time that I have to give up what little personal time I have in the morning, evening and on weekends if I want to continue to provide excellent care during office hours.

If high-quality medical care is the goal, the bureaucracies need to be tamed. Our government and insurance companies understandably want to measure outcomes of health-care dollars spent. However, if the health-care system rewards data entry, that is what it will get—the quality of care seems an afterthought.

The patient should be the arbiter of the physician's quality of care. Contrary to what our government may believe, the average American has the intellectual capacity to judge. To give people more control of their medical choices, we should move away from third-party payment. It may be more prudent to offer the public a high-deductible insurance plan with a tax-deductible medical savings account that people could use until the insurance deductible is reached. Members of the public thus would be spending their own health-care dollars and have an incentive to shop around for better value. This would encourage competition among providers and ultimately lower health-care costs.

By contrast, the Affordable Care Act's plans for establishing "medical homes"—a team-based health-care delivery model—and accountability-care organizations will only add more bureaucracy and enrich the consultants and companies organizing these entities.

To improve quality, we need to unchain health-care providers from the bureaucracies that are strangling them fiscally and temporally. We can better control medical costs if we strengthen physicians' relationships with their patients rather than with their computers.”

“Dr. Sklar is an assistant professor of medicine at the Georgetown University Medical Center and at the George Washington University Medical Center.”

I hope all the consumers of healthcare can feel the pain physicians are experiencing in delivering care on their patients behalf because of Obamacare.

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.

CMS administers Medicare and Medicaid. CMS was restricting payment for outpatient procedures and tests done in freestanding practicing physicians’ offices while paying higher fees for the exact same outpatient hospital procedures and tests.

As rules and regulations and the complexity of the business of practicing medicine in private freestanding outpatient clinics increased physicians sold their practices to hospital systems.

The government and the healthcare industry encouraged these sales by increasing the complexity of running a private practice.

The probable logic was they would only have to deal with one entity (the Hospital System) rather than 600 individual doctors or clinics using that hospital system.

The government’s excuse for cutting out freestanding individual practices and clinics was efficiency and patient safety.

The hospitals were overjoyed to be able to buy physician practices.

“As the Affordable Care Act attempts to steer people away from pricey hospital inpatient admissions, hospitals have begun buying up doctors’ offices in hopes of increasing their revenue and market share.”

The hospital systems’ then discovered they were losing money by buying physicians’ free standing practices.

In essence they were trying to buy physicians’ intellectual property and surgical skills because the traditional brick and mortar hospital building was becoming less profitable. Many surgical procedures were being done as outpatient procedures.

Physicians were less productive as hospital employees than they were when they owned their own practices. They were guarantied a salary.

Hospitals did not bother to calculate the money they made from doing the entire outpatient testing and procedures when presenting the loss to the government.

Hospital systems have been selective, first buying Primary Care Physicians’ freestanding office practices. Next they started trying to buy oncology practices.

To further encourage physician owned clinics to migrate to hospital system owned practices the government and the healthcare insurance industry provided separate revenue codes to allow hospital systems to collect more for the same tests and procedures done in physicians’ free standing offices.

As hospital system merge the price will go up even further. The hospital systems are now negotiating from a position of strength. Hospital systems are making the money as private physicians’ reimbursement shrinks.

The government and the healthcare insurance industry are finding their scheme to destroy private practice was a big mistake.

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone. Please have a friend subscribe

The article is about the need for prior authorization to reduce drug costs in an insured patient. As you read this, think of the increase in the insurance company’s administrative waste, and the disrespect for the physician’s time and judgment.

Millions of prior authorization letters are sent every day for drugs, hospitalizations, and treatment plans. They are the result of actions that do not fit into a healthcare insurance company’s computer algorithm.

Insurance company workers know little about medical care these prior authorizations are challenging. These workers know little about medical judgment or medical care.

The healthcare insurance industry believes it is an effective way to prod physicians away from more expensive treatments and toward less expensive alternatives.

It makes it harder to prescribe costlier medications. In reality, it is a wasteful administrative nightmare.

But Mr. V. had changed insurance companies, and now one of his medications required a prior authorization. The last thing I wanted was for him to be turned away at his pharmacy and have his blood pressure spiral out of control, so I called right away to sort things out.

Twenty minutes of phone tree later, I discovered that the problem was that I had exceeded a pill limit for one of his medications. Mr. V. needed to take 90 of those pills each month for the high dosage that his blood pressure required. I patiently explained this to the customer care representative.

Equally patiently, she told me that 45 pills a month was the maximum allowed for this particular medication.

Three more phone trees and three more customer care representatives later, my patience was flagging. Apparently a request for 90 pills was flummoxing the system. Representative No. 4 went down her checklist. “Would taking 45 pills per month instead of 90 pills adversely affect Mr. V.’s health?” she asked.

At first I thought she was joking. “Well,” I replied, “it would probably make his blood pressure shoot up in the second half of the month.”

She paused, then asked her next question with the encouraging uplift of suggestion. “Has Mr. V. ever tried 45 pills per month instead of 90 pills?”

Then I realized that she was not joking. “Are you out of your mind?” I hollered into the phone. “It’s taken years — years! — to find the right combination of meds to control his blood pressure without killing his kidneys or making him dizzy or nauseated or depressed or ruining his libido or running his potassium off the charts or breaking his bank account. Do you really think I’m going to randomly jiggle the dosages just for the hell of it?”

“A simple yes or no will suffice, doctor.”

This interaction demonstrates a lack of respect for the physician and his judgment, and a lack of understanding of the patient’s illness. I have said over and over again that you cannot commoditize patients’ illnesses or physicians’ skills.

If the insurance company’s computer system has a beef with physicians’ judgment it should get a second opinion by a neutral expert physician in the field of hypertension to review the chart and the patient’s illness.

“I’m all for controlling medical costs and trying to apply rational rules to our use of expensive medications and procedures. But in the current system, everything seems to be in service of the corporate side of medicine, not the patient. The clinical rationale and the actual patient — not to mention the doctors and nurses involved in the care — are at best secondary concerns.

In the end, we were able to keep Mr. V.’s blood pressure under control. My blood pressure, however, was a different story.”

These interactions go on daily and waste physicians’ time and energy. Physicians have no ability or representatives to fight back. However, they are ready to fight back. All they need is someone to come up with a plan.

A good start is changing the paradigm of healthcare insurance so that it is a consumer driven healthcare system with consumers being in charge of their healthcare dollars and their health.

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone. Please have a friend subscribe

Many of my readers have asked me to explain drug pricing. I have not covered the pharmaceutical industry’s pricing in this blog because I have not been able to figure out drug pricing.

I do know there is a lot profit in both the retail and wholesale drug business. I know government pricing is different that benefit management pricing. I know there has been a growth in drug benefit management companies.

My sense is neither the pricing for Medicare Part D or private insurance drug benefits are for the patients’ advantage.

I recently asked a good friend Dr. Dale Fuller, a retired radiation oncologist, to explain the outrageous cost of oncology drugs (Drugs used to treat patients with cancer).

I wanted to know the reason the government pays almost twice as much to hospitals for the same treatment patients get in the oncologist’s office even though the treatment is given by the same oncologist.

I have added a couple of comments to Dr. Fuller’s note into the body of his reply.

Dr. Fuller writes,

"Is pharmaceutical pricing weird, or what?"

Dale Fuller M.D.

"Lately I have been thinking about pharmaceutical pricing, and as an old pharmacist turned radiation oncologist, it was the pricing of cancer drugs that caught my interest.

Then, my wife showed me some information about a product called “Symbicort” that she uses on a regular basis.

Introduced into the US in March of 2009, it goes off patent in 2014. The other day she brought home a 90 day supply for which she had paid $120.00, and Medicare part D allegedly paid $839.89. At least, the package from Walgreen’s informed her that her “insurance had saved her that $839.89”.

The $839.89 plus the $120 or $959.89 is going to be charged against her Medicare Part D donut.

During the initial coverage phase, you pay a copayment or coinsurance, and your Part D drug plan pays its share for each covered drug until your combined amount (including your deductible) reaches $2840.

When you spend more than $4,550 out-of-pocket, the coverage gap ends and your drug plan pays most of the costs of your covered drugs for the remainder of the year.

The patient will then be responsible for a small copayment. This is known as catastrophic coverage.

In 2014, Medicare will pay 28% of the price for generic drugs during the coverage gap. You'll pay the remaining 72% of the price.

What you pay for generic drugs during the coverage gap will decrease each year until it reaches 25% in 2020—in 2015, you'll pay 65% of the price for generic drugs during the coverage gap.

Confusing isn’t it.

That would be a total of $959.89 for her 3 months’ supply of medication, or $319.96 a month, or $2.67 a squirt, of which there are four a day. Who knows how much Uncle Sam actually paid Walgreen’s for his share of the bill.

However a senior cannot buy this inexpensive brand named Symbicort using his Medicare Part D drug plan because he would be buying it from a Canadian Pharmacy.

So much for competitive innovation in a global economy. Government control trumps innovation.

Similar abstruse drug pricing strategies exist in abundance in the field of medical oncology.

Consider first the situation in the office of the medical oncologist. The physician purchases pharmaceuticals from a supplier. He must retain at least a basic inventory of frequently used products, some of which are very expensive.

The “acquisition cost” becomes the basis for the reimbursement the doctor receives from Medicare for the drug. To the acquisition cost the doctor was allowed to add 6%, which was intended to cover the preparation for administration.

The actual infusion of the medication in the doctor’s infusion room, including the cost of the nurses working there, was reimbursed at a rate of $133 per hour (“chair time”). Keep that figure in mind.

The US budget debacle in which Uncle Sam cut everything he paid for by 2%, actually amounted to a 33% reduction in the 6% the doctor was allowed, leaving ~4% to underwite the preparation for administration of the drug required for the care of a Medicare patient.

There are other patients who come to the infusion room, as well. Some have private insurance, and some have no insurance at all.

The private insurance may carry a different level of reimbursement for pharmaceuticals from that paid by Medicare, or it may not.

Very few uninsured patients have the wherewithal to pay out of pocket for the cost of their care. The doctor has two choices in handling their situations: charity or referral to a hospital where the cost of chemotherapy agents and their administration is handled in a different way.

The absence of any significant profitability for many medical oncologists has resulted in the closure of at least 400 practices between 2007 and 2012, and closures continue to this day. Patients in these situations have been forced to seek outpatient infusion services in local hospitals, where administration reimbursement to the hospital is an average of $299 per hour in comparison to $133 in the doctors’ offices.

It is said that hospital outpatient infusion services use more drugs (see below for how they are acquired), charge higher prices, and require higher co-pays from patients. Go figure.

And, don’t forget the drugs! Doctors are now reimbursed by Medicare at acquisition plus 4%, while hospitals, under “340B” programs enjoy a margin of about 30% versus the doctors’ 0-2%.

Remember the Symbicort example I started with? The 304B acquisition price for Symbicort is listed at $88! Even with a 50% markup for a patient, a month’s supply would come to $132. Go figure.

The evolution of this mess has prompted a congressional advisory organization called MedPac http://www.medpac.gov/ to call for changes to equalize payments for oncologists’ care in their offices as compared to payments for services provided in hospital outpatient departments. And, who can argue against the creation of a level playing field?

Symbicort is now generic. I tried to find the price of the generic drug. I could not without providing a prescription. Go Figure. Is this transparency?

Patients and physicians are being taken advantage of here. They are the pawns that drive the profits in the healthcare system.

Someone has to stop it for the sake of good medical care delivery.

I wish to thank Dr. Dale Fuller for this submission.

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone. Please have a friend subscribe

The state insurance regulators are supposed to protect consumers again abuses by the healthcare insurance companies. Many State Boards of Insurance have not administered their responsibility effectively.

The federal government put out for bid the administration of the federal programs such as Medicare, Medicaid and the VA systems. It has not done this job very effectively. There has been much fraud and abuse in this system.

Somehow the healthcare insurance industry has talked these regulators into permitting the insurance industry to take 40% of the healthcare premiums off the top.

Obamacare mandated a Medical Loss ratio of 80/20. Eighty percent of the premium dollars are to be spent on direct patient care and 20% can be held back for expenses and profit.

However, the regulatory agencies have permitted an additional 20% of expenses to be written off as direct patient care.

The details of these expenses are so complex that few can understand the direct patient care expenses.

Recently, we have heard that if the insurance demographic mix is inappropriate, provisions are written into Obamacare that permit the healthcare insurance industry to achieve a profit.

If it does not reach its profit goal, Obamacare will bail out the healthcare industry. The traditional media has not paid much attention to this provision.

High deductible healthcare plans are very attractive to people who are at low risk for disease. If an unforeseen illness occurs they could buy an inexpensive first dollar coverage plan.

Obamacare is slowly eliminating those plans.

President Obama is trying to drive everyone into a health insurance exchange plan in the name of creating competition among insurance companies. His administration is also picking preferred insurance companies to sell these plans state by state.

President Obama is also choosing hospitals to participate in the state insurance plans’ networks. In some states the insurance company choices are thin to nonexistent. An example is New Hampshire with one healthcare insurance vendor. The same state has eliminated two thirds of hospitals and physicians eligible to participate in the health insurance exchanges.

Some of the best hospitals and clinics are not participating in the exchanges. In some cases reimbursement is too low.

Obamacare’s excuse is this will eliminate the facilities that overcharge and eliminate the risk of cost overruns.

All this keeps the healthcare insurance industry in charge of the risk. In order to reduce costs patients have to be motivated to avoid illness and be responsible for their own health and healthcare dollars.

This concept is not embodied in Obamacare. The government and the healthcare insurance industry will make the healthcare decisions for consumers.

Another big idea included in Obamacare is the concept of shifting risk from the government and the healthcare insurance industry to physicians and consumers.

There are no provisions for risk weighting payments to physicians for disease complications resulting from patients’ lack of adherence to treatment. The more complications of a chronic disease patients have the greater the risk of higher costs that cannot be controlled.

ACO’s bundle payments for disease entities. One size does not fix all.

ICM-10 increases the number of diagnostic and treatment codes from 18,00 to 68,000 codes. This increases the complexity of coding. It is an opening for fraudulent coding. It also can result in the possibility of over or under coding as well as miscoding. It will take years to learn and years to get right.

If physicians miscode those physicians will not get paid by the government or the insurance industry.

This brings us to the next barrier to the success of Obamacare. There is a constant threat of penalty to consumers and physicians. There should be a constant incentive to receive a monetary reward.

Consumers have higher deductible and higher premiums with Obamacare. Many middle class people cannot afford the higher premiums and higher deductibles. The government subsidizes the healthcare insurance for the poor.

The funding for these subsidies is unclear. It will probably result in yet another tax increase for the middle class. The poor are exempt from income tax payments.

There are no incentives for anyone to stay healthy and avoid unnecessary and expensive physician visits and diagnostic testing.

There is no tort reform in Obamacare. The lack of tort reform increases the need for excess testing in order to avoid lawsuits for physicians not doing a complete workup.

Physicians and hospital systems have never figured out how to calculate Health Maintenance Organizations’ reimbursement. Physicians and hospitals lost a great deal of money trying to price HMOs bundled payments.

Physicians and hospital systems know less about pricing bundled payments for ACOs. They have no control over consumer usage even though they are being asked to cover the risk. They are hesitant to assume risk.

This is part of the reason ACO participation has been so poor as I pointed out in my last blog.

It is Insurance coverage (public or private) that should cover and assume the risk. This is the definition of insurance. It is not in the physicians power to control risk nor should it be his responsibility.

It is the responsibility of the State Insurance Boards to price that risk for the healthcare insurance industry wisely. These boards should provide a wide range of products to fit consumers needs. The consumer should have the freedom to choose.

Federal and State officials should not accept the insurance industry’s word.

It is unacceptable.

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone

Some have complained that "My Ideal Medical Savings Account" cannot work. I have communicated with some of these people who made this and similar comments. I discovered two common themes to their comments.

The first theme was that people are too dumb to take care of themselves and make their own medical decisions.

The government must make the healthcare decisions for them.

The second was people would not handle their healthcare dollars appropriately if they were given the money.

These people might be talking about 5% per of the population who will be a burden to society no matter what healthcare system is put into place.

Why burden the other 95% of the population who want to be responsible for their health and healthcare dollars if they were given the chance?

The chance given has to include complete transparency, equal tax treatment, and adequate education to use their healthcare dollars wisely to made wise medical care decisions.

MSAs provide added incentives over HSAs to obtain and maintain good health. Obesity is a major factor in the onset of chronic diseases. Consumers must be motivated to avoid obesity to maintain good health. MSAs can provide that incentive.

The MSA’s can replace every form of health insurance at a reduced cost. It limits the risk to the healthcare insurance industry while providing consumers with choice.

This would result in competition among healthcare providers. Competition would bring down the cost of healthcare.

Some people might not like MSA’s because they are liberating. They provide consumers of healthcare with freedom of choice. They also give consumers the opportunity to be responsible for their healthcare dollars while providing them with incentives to take care of their health.

MSAs could be used for private insurance purchasers, group insurance plans, employer self-insurance plans, State Funded self-insurance plans and Medicare and Medicaid.

In each case the funding source is different. The cost of the high deductible insurance is low because the risk of spending $6,000 for most people is low.

If it were a $6,000 deductible MSA, the first $6,000 would be placed in a trust for the consumer. Whatever they did not spend would go into a retirement trust. If they spent over $6,000 they would have first dollar healthcare insurance coverage. Their trust would obviously receive no money that year.

The incentive would be for consumers to take care of their health so they do not get sick and end up in an expensive emergency room.

If a person had a chronic illness such as asthma, Diabetes, or health disease with a tendency to congestive heart failure and ended up in the emergency room they would use up their $6,000.

If they took care of themselves by spending $3,000 of their $6,000 trust their funding source could afford to give their trust a $1500 reward. The benefit to the funding source is it saved money by the consumer not being admitted to the hospital. The patient stayed healthy and was more productive.

President Obama does not want to try this out. He wants consumers and businesses to be dependent of the central government for everything.

MSAs would lead to consumer independence from central government control of our healthcare. MSAs would put all consumers at whatever socioeconomic level in charge of their own destiny.

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone

I formulated an alternative to Obamacare in 2006, long before Obamacare existed. President Obama has ignored a plan that will work and align every stakeholder’s incentive.

Obamacare is failing because President Obama does not know who the customer is in the healthcare system. He is blinded by ideology and the belief that government knows what consumers need.

The consumer is the customer. Without consumers of medical care and physicians to provide medical care we would not need a healthcare system.

Consumers and physicians are the primary stakeholders. All the others are secondary stakeholders.

However, physicians receive between 15-20% of the healthcare dollars. Hospitals receive 25% of the healthcare dollars.

Where does the remaining 60% of the healthcare dollars go?

The insurance industry takes at least 40% off the top. The pharmaceutical industry receives 10% and the government wastes 10%.

It is a pity that only 40% of our healthcare dollars is spent on direct medical care. There is much waste and inefficiency built into that direct medical care.

There is also much waste included in the 60% the secondary stakeholder take off the top.

How else would UnitedHealth’s CEO get paid $1.8 billion dollars in cash and stock options from 1998 to 2006?

The excessive insurance industry profits are the direct result of ineffective regulatory agencies controlling insurance pricing.

In 2006 consumer power was demonstrated when UnitedHealth tried to decrease reimbursement to Hospital Corporations of America. HCA protested and threated to quit participation in United Health. Consumer protests followed.

UnitedHealth was the main insurance carrier in the Denver Area. Consumers threated to boycott buying insurance from UnitedHealth. UnitedHealth backed off.

In 2006, many of the uninsured were self employed consumers who cannot qualify for insurance because they have a preexisting illness or they are at risk for illness.

The insurance companies refused to sell them insurance. The same consumer in a group insurance plan by law would receive insurance from the same insurance company that turned down the individual.

A self-employed individual can only buy insurance with after tax dollars. A corporate employee receives healthcare insurance coverage with pre-tax dollars.

The same applies for the individual insurance market post Obamacare.

The price of insurance is very high for small businesses. The small business owners do not have the negotiating power of the large corporations.

This results in both the individual and small business not being covered by healthcare insurance. All of the above can be easily fixed.

The problem with Obamacare is the insurance premiums are higher than they were pre- Obamacare. The reasons are obvious.

The only winner is the individual who makes a low enough income to receive a federal subsidy. The loser is the taxpayer.

Obamacare also creates a perverse incentive resulting in people not striving to get ahead.

In 2006 I wrote:

Patients drive the healthcare system. Patients have tremendous power. They must be taught to use that power in order to Repair the Healthcare System.

Patients must use their “Patient Power” to take control of their healthcare dollars and their health. They should be provided with financial incentives to save the money they spend on medical care.

Neither the healthcare insurance industry nor the government should determine the consumers’ access to care. Patients’ freedom of choice and self- responsibility is the key to Repairing the Healthcare System.

If there are financial incentives consumers will learn to become informed consumers of healthcare. Reliable education must be provided to give consumers the opportunity to become informed consumers.

There are preconditions.

Prices must be transparent so consumers know what they are buying. The insurance industry should negotiate the price with the physicians and the hospitals. The industry can remain the surrogate broker for the payment of money belonging to the consumer. Consumers’ who overspend will not receive the financial incentive. They will lose their medical saving account money. Patients who have an expensive illness, like diabetes, can be rewarded for spending money if they keep themselves in good health and prevent complications of disease.

The consumers are then the responsible party purchasing their medical care. It is not the healthcare insurance industry or the government.

The healthcare insurance industry or any financial industry with an adequate computer system can be the administrator and adjudicator of payment.

The medical outcome is a dual responsibility of both consumers and physicians. Consumers should be made aware of physicians’ outcomes. Some of the poor outcomes are the result of consumers not taking the responsibility to learn about their disease, prevent the complications of their disease, or comply with the treatment recommended. The result is a poor outcome.

Consumer overspending is another important aspect of increasing healthcare costs. Consumers do not have incentive to be cautious with their healthcare dollars because they have been given first dollar coverage. They do not have financial incentives to save money on medical care.

The Health Saving Accounts that congress has approved in my opinion is impotent. It does not provide a strong enough financial incentive for consumers to want to save money.

The trust account of $1,000 per year is too low to motivate consumers to become wise shoppers. A Medical Savings Account of $6,000 per year begins to represent financial motivation.

HSA’s represent the same false hope HMO’s and managed care represented in the 1980’s and 1990’s.

Dr. Fuchs calls it “The Restaurant Check Problem.”

“You go out to a restaurant with a bunch of friends and you sort of understand that you will split the check,” he said.

“The waiter comes along and says, ‘the lobster looks very good, and how about a soufflé for dessert?’

The restaurant check balloons, but you are not so careful because you figure everyone is splitting it.

“That’s the way medical care gets paid for,” he said.

Dr. Fuchs added, “We want to spend our money on the things that will bring the most value for the dollar.

When we are spending collective money as we are in health care, then it becomes much more difficult.”

We want Diabetics to spend money for good medical care in order to prevent complications. Prevention of complications will keep Diabetics out of the hospital and out of the emergency room. The result will be a decrease in medical costs.

The consumer driven healthcare plans can be set up to give provide Diabetic consumer the financial motivation to take care of himself. This reward is much cheaper than paying for a hospitalization or emergency room visit.

If an insurance product is overloaded with salaries, waste, overhead and unnecessary benefits patients will not buy the product.

The insurance product would have to be modified. It would become more cost efficient.

Patients have it in their power to remove the waste and inefficiency in the system.

Some very clever entrepreneur will realize the consumer is the customer. He will develop an insurance product that everyone wants. State governments have the power to encourage development of this product.

The examples in industry in America are numerous. Sam Walton revolutionized retailing in America with Wal-Mart and Sam’s. Michael Dell almost brought IBM to its knees and revolutionized the distribution of information technology.

I hope to show the way to develop an insurance product that can work for patients first and then all the other stakeholders.

There is no reason we cannot provide excellent affordable insurance coverage to all including the corporate employed, the small business employed, the self employed, the unemployed, and the Medicare covered seniors, with all the stakeholders making a reasonable profit in a simplified system.

President Obama, I have provided a viable alternative long before you became President.

I also provided this alternative to you when you became President in the letters I wrote to you.

For you to say no one has come up with a better alternative than Obamacare is disingenuous on your part.

I hope you are listening now.

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.

It is all about concentrating control over the healthcare system in the federal government. It is about increasing profits of the healthcare insurance industry. It is about decreasing consumers’ freedom to choose a physician. It is about inhibiting physicians’ freedom to use clinical judgment.

It is designed to happen slowly and insidiously. The trick is to increase control and decrease freedom so that it is not noticed until after it has happened.

Obamacare will not collapse in the next day or two. It will take months to a few years before the major stakeholders (consumers/patients) realize what has happened to our healthcare system.

Only when every consumer is affected will there be a unified public community outcry to repeal Obamacare.

It might be too late at that time. All the stakeholders will have adjusted to the new but unsuccessful healthcare system at the taxpayers’ expense.

Socialized medicine has not been cost effective anywhere in the free world.

Eighty percent of the people are not sick at any one time. The healthy think the socialized healthcare system in their society is fine until they get sick.

Most people do not realize that the bureaucratic costs and inefficiency in a socialized medicine system consume a high percentage of the GNP.

Americans would not tolerate 50% of the GNP going to the healthcare system. Especially when the quality of care and access to care has diminished along with the rationing of care.

Medical care is personal. Commoditization of medical care is not personal. When consumers realize they do not have the freedom to choose there will be a reaction.

President Obama’s public relations machine is pumping out deceptions and half-truths right and left about the success of the web site in December without producing any facts except the number of people who visited the site. The implication is these consumers have signed up and received healthcare insurance.

The defects in the implementation are too numerous to count. The New York Times is not deterred. It is regurgitating the Obama administrations press releases. The administration admits the rollout has had a lot of glitches. However, the administration as well as the New York Times has said that over time all Americans will all be happy with the results of Obamacare.

The mainstream media is spinning President Obama’s story.

Eugene Robinson of the Washington Post started off the New Year with the following statement.

Any existential threat to the Affordable Care Act ended with the popping of champagne corks as the New Year arrived.

“That was when an estimated 6 million uninsured Americans received coverage through expanded Medicaid eligibility or the federal and state health insurance exchanges.”

“ObamaCare is now a fait accompli; nobody is going to take this coverage away from the millions of uninsured”

Let us keep half-truths in perspective. Where did Eugene Robinson get the fact that 6 million people got insurance coverage on the health insurance exchanges?

Over 6.5 million people lost their healthcare insurance already under Obamacare and 48 million people were said to be uninsured before Obamacare. President Obama promised that 30 million new people would receive insurance under Obamacare.

These calculations should give most thinking people a headache.

Carl Sandburg, in the Prairie Years ,said that a liar has to have a good memory. However, if you tell enough lies and cover them with enough distractions the audience experiences information overload and doesn’t remember the lies.

It seems to me that Obamacare does not solve any of the problems in the healthcare system.

It is going to make the healthcare insurance industry richer, the pharmaceutical industry richer and the middle class poorer as coverage is reduced, deductibles are increased, access to care is reduced and rationing of care is increased.

Access to medical care should be universal.

Obamacare changes the entire healthcare system. It permits 20% of the population to have access to healthcare insurance while destroying the present healthcare coverage system for 80% of the population. Most of that 80% claim they liked their insurance and their doctor.

President Obama lied to them when he told them they could keep their insurance and their doctor. He is now telling them Obamacare is for their own good.

Why should the government decide on our healthcare coverage?

Healthcare insurance never made people healthy. People help themselves stay healthy.

The main issue is the present healthcare system is unsustainable.

Medicare and Medicaid are unsustainable.

The private employer sponsored healthcare system is unsustainable.

The Veterans Administration healthcare system is unsustainable.

The present and impending failures of Obamacare are unsustainable.

What can America do?

The consumer’s responsibility is missing from the entire discussion. How do you create a system that lets consumers be responsible for their health and healthcare?

How do consumers stop healthcare insurance executives from making obscene salaries and drug companies obscene profits?

It is by consumers not buying their products.

There must be total transparency of healthcare products available to consumers. Consumers must be educated to evaluate these products. Only then can consumers choose the best healthcare and medical care value for them.

There must also be a financial incentive for consumers to be responsible for their own healthcare and medical care decisions.

It is not by imposing an ideology that promotes central government control of the healthcare system.

It is not by creating more entitlements

Government bureaucracy is inefficient. It does not help the masses. It helps insiders. It leads to cost overruns.

It stifles innovations.

It is not by imposing a system of redistribution of wealth that is going to fix the healthcare system.

Politicians are forced to disguise the redistribution of wealth because it threatens their re-election prospects.

Our elected officials passed the 10 hidden taxes that have been in force for four years going on five to finance Obamacare before it is fully implemented.

The costs of these taxes have been passed on to consumers. The majority of consumers are in the middle class. They are paying for these taxes indirectly.

In reality President Obama is taxing the working middle class and lower class as well as people making over $250,000 a year. Despite these increased in taxes Obamacare still in for more cost overruns.

The taxpayers’ problem is the administration is unwilling to reveal these cost overruns.

President Obama recently promised to bail out the healthcare insurance industry if they lose money on Obamacare.

This promise is almost as upsetting as providing a waiver to Congress from Obamacare.

Government’s role is to educate consumers.

It is not to create increasing entitlements to have more and more central control over the population.

Entitlements do not work!

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.

The added required benefits mandated
in insurance coverage in the law and the way the healthcare insurance industry
is permitted to calculate its Medical Loss Ratio makes President Obama’s
calculation impossible.

President Obama has been telling
the American public a lie all the while. People are starting to understand.

The average one month premium
change from buying insurance in the non-group market in 2013 versus the
Obamacare exchanges in 2014 is not revealed in any government statistics. Two
studies were completed by private sources.

Premium comparisons between
2013 and 2014 are not available from Health and Human Services (HHS).

The 2013 premiums increased
by double digits from the 2012 premiums because of Obamacare. The traditional
media has not pressed the government to provide these comparisons.

The media continues to quote
the administration press releases of lower premium prices. The Obama administration uses CBO estimates
of premium prices calculated in 2010 for 2016 by data provided by the Obama
administration. The tradition media refuses to report reality.

The Obama
administration’s methods of deception are cunning, powerful and effective.

He always blames others and hides his ideology.

President
Obama continues to try to fool a majority of the people most of the time.

Americans will
get the point where the rubber meets the road. The public is going to
have to reach into their pockets and pay these enormous increases in premiums
or not buy healthcare insurance coverage.

Taxpaying
Americans are also going to experience massive increases in taxes above and beyond those already experienced.

I predict the
public outcry will drown out the spin of the Obama administration. The
traditional media will not be able to ignore this public outcry.

People will
finally realize the enormous government grab of power and control of Obamacare at
taxpayers’ expense.

People
can’t complete applications or secure premium prices on the health insurance
exchanges because of technical problems resulting from ancient information technology
used by the government to construct the exchanges.

All of the
consumers’ demographics must be filled out before the government provides a
premium price. There is at tricky reason for this.

This
computer “glitch” solidifies my view that President Obama wants Obamacare to
fail in order to replace it with a single party payer system that America
cannot afford.

This last
statement is counterintuitive but I believe true.

Is it wise
for consumers to hand over all their medical decision making to a government
that has this much difficulty with executing a computer program and providing
healthcare insurance premiums?

Americans
must wake up soon. They have to insist on a consumer driven healthcare system
in which they have control over their healthcare and their healthcare dollars.

Each day it gets worse
despite the fact the President Obama keeps saying Obamacare is great and will save us
money. Americans do not believe him.

If you are a big
government control advocate, the ideology of Obamacare could be applauded.

Practically, Obamacare is
naïve and an impending “train wreck.”
Unintended consequences keep appearing because of defects in the theory and poor
design.

Patients, the healthcare
care insurance industry, physicians, hospital systems, and drug companies could
have predicated these unintended consequence if they knew what was it the bill
at its passage. Those who did understand the Accountable Care Act (Obamacare)
hated the act at its passage.

Many of my progressive
friends blame the problems Obamacare is having on Republicans.

I think they are getting
that idea because the New York Times and its editorial op-ed writers that are making
that claim. However, the New York Times offers no concrete proof.

Obamacare is failing on it
own. Its implementation gets harder and more expensive each day.

On July 12, James Hoffa of the Teamsters (1.4
million members), Joseph Hansen of the Food and Commercial Workers (1.3 million
members) and D. Taylor of UNITE-HERE (200,000 members, mostly culinary and
hotel workers) wrote to complain about the president's Affordable Care Act.

Obamacare is destroying
the 40-hour workweek unions worked many years to achieve. Employers are hiring part time employees to replace full
time employees that had been laid off because of the recession.

Employers are doing this
to avoid a $2,000 penalty for not providing healthcare insurance for each employee.

The majority of the job
growth figure of 195,000 for June consisted of part time job growth.

After
all, employers can avoid a $2,000-per-worker penalty if they don't provide mandated insurance as long as employees
work fewer than 30 hours a week.

" Union leaders have realized—too late—that
ObamaCare will affect the livelihood of millions of workers who wait tables,
wash dishes, clean hotels, man registers, stock shelves and perform other tasks
that can be limited to shifts of less than 30 hours a week."

White
house Press Secretary Jay Carney said it "is
belied by the facts."

Once
again he was lying. He used 2010 Bureau of Labor Statistics numbers to answer
the complaint.

Three big unions
worry that the health law will hurt their members' benefits and paychecks.

The letter to Nancy
Pelosi and Harry Reid was unusually harsh.

The letter was not from
Mr. Obama's GOP adversaries but from the president’s allies, the big three most
powerful unions. A fourth union joined the group a few days later.

The unions finally
realized that Obamacare was going to cut unions out of some government
subsidies. Obamacare makes a unionized workforce more expensive for employers. It makes it less attractive for workers to
join unions.

Further, the unions
nonprofit insurance plans are subject to "Obamacare’s new 2-3% tax on each
insurance policy they place."

The union wants their members
exempt from this tax because the union will be forced to pass it on to their
members. Members will be forced to use the health insurance exchanges to buy
their healthcare insurance.

Unions are starting to
realize the goal of Obamacare is to force everyone into his “Public Option”
that will default to a single party payer. The result will be complete
government control of the healthcare system.

There are three insurance
options in the health insurance exchanges. Citizens will buy the cheapest
“affordable option.” The deductibles
will be high. Citizens will have to pay deductibles out of pocket decreasing
their purchasing power.

“He said the strategy would haunt Republicans next year among
moderate and independent voters who want changes, not outright repeal.”

Republicans need an
innovative alternative to Obamacare that will work and excite the public. They need a plan that will put consumers in
charge of their health and healthcare dollar. Consumers do not want a healthcare
system that puts the government in charge of their health.

Hospital
Systems inflate their prices for many reasons. Some insurance companies pay
more than others for hospital systems’ services. Hospital systems do not know
what the consumer’s insurance would pay when consumers come into the hospital
so they register the highest prices on the consumer’s bill.

Hospital
systems try to charge as much as they can to collect as much as possible. The
pricing is not based on reality.

Surgery Center of Oklahoma started posting their prices online
about four years ago.

The prices for procedures are
all-inclusive quotes and are guaranteed.

The result was to start a local price war.
The Surgery Center of Oklahoma is disruptive to the hospital pricing in its
community. This disruptive pricing is spreading across the nation. Consumers from
all over have come to the Surgery Center of Oklahoma because the price is
transparent and reasonable compared to hospital systems in their local area. One
specific example is.

Mr. Gang is uninsured. He lives in California.
Surgery in his California community was going to cost him about $30,000.

The Surgery Center of Oklahoma Internet
price was $5,700.

Matthew and his father Tom Gang flew from
California to Oklahoma for surgery.

“It was well worth it,” Tom Gang said. “I need a rotator cuff
surgery right now. I’m thinking about flying out there and having my surgery
because it was such a positive experience for us.”

Other Oklahoma medical and surgical
facilities have started joining Surgery Center of Oklahoma in posting prices
and becoming price transparent. Hospital systems are realizing they will have
to compete with low price transparent prices to attract patients.

Surgery Center of Oklahoma does accept
private insurance, but the Center does not accept Medicaid or Medicare.

Rather
than crying about the issue of the lack of price transparency as Dr. Uwe
Reinhardt did in my last post, someone is actually doing something about it. It
is causing hospital systems and large clinics to lower prices and make them
transparent.

"A new
provision buried in Obamacare effectively prohibits doctors from
starting their own hospitals or expanding the hospitals they already own, which
has been widely interpreted as a give-away to the American Hospital
Association."

As patients are starting to demand price
matching, some hospitals are giving in.

“Hospitals are having to match our prices because patients are
printing their prices and holding that in one hand and holding a ticket to
Oklahoma City in the other hand and asking that hospital to step up,” Dr. Smith
said. “So we’re actually causing a deflationary effect on pricing all over the
United States.”

Physicians are waking up and realizing
they are not the main cause of escalating costs. The Surgery Center of Oklahoma
is a wonderful example of a price transparent organization that is doing
something to force price competition.

It is clear. The government is not going
to create price transparency.

Physicians and patients must drive the adoption of a free market
place.

Consumers must drive price transparency.

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone

I believe the New York Times is doing a great disservice to the American
public in its biased promotion of the virtues of Obamacare. The intellectuals
of our society read the Times and never question this bias. In fact the Times
publishes letters from these intellectuals that confirm its biased statements. The more letters that come in the more they
are published. Before anyone knows it the bias becomes the truth.

It goes through this woeful story of how an uninsured
pregnant woman tries to find a best price for her delivery from hospitals in
her community.

“Here is what happened to my daughter, Therese Allison, when she
tried to be just the sort of shrewd and informed patient that politicians
should love.”

At this point I realized the article was another New York
Times propaganda article implying the potential virtues of Obamacare. President
Obama and the Democrats have mandated that patients like this buy healthcare
insurance from health insurance exchanges. They want patients to be dependent
on the government and not give patients the choice to make their own independent
choices.

The healthcare system’s dice are loaded against this woman’s
independent free choice.

Therese’s midwife offered to call the two hospitals the midwife
uses. She wanted pricing for an uncomplicated normal vaginal delivery without
an epidural. Therese’s plan was to leave the hospital the next day.

One hospital gave her a conditional price estimate. The other
didn’t. The second told her to apply for Medicaid. She thought there should be
a law making hospital systems reveal their prices.

Uwe Reinhardt, a
Princeton health care economist who is a frequent contributor to The New York
Times said hospitals do not have to their reveal prices.

“When I was chair of the New Jersey commission on hospitals two
years ago, my wife, at my behest, tried to get a price for a normal delivery
from the Princeton Medical Center,” Dr. Reinhardt said. “She pretended to be an
uninsured entrepreneur earning $80,000 a year. She got nowhere. I then called
to try out a colonoscopy. I got nowhere too.”

Dr. Reinhardt is a big fan of Obamacare. His implication is the
Obama administration is going to fix the non-transparency barrier.

The Obama administration has tried to break the price
transparency barrier by publishing Medicare and Medicaid prices. The effort is
confusing, insufficient and incomplete.

Medicare and Medicaid reimbursements have been published in some
states in the past. Private insurance reimbursements to hospital systems have
been published for some diseases but it has been incomplete and
incomprehensible.

These reimbursement figures have been difficult to find on the
Internet. Additionally the prices have nothing to do with private healthcare insurance
contract prices of private insurance co-pay.

The Obama administration just had Medicare publish a giant spreadsheet with its payments for
the 100 most popular hospital procedures and treatments in 3,000 hospitals
across the country using claims data.

Pregnancy is not on the Medicare spreadsheet list along with
many other common procedures. The claims data is not connected to private
insurance payments and co-pays. As I have pointed out in the past, claims data
is notoriously inaccurate.

What is needed is a smartphone app listing prices for consumers
by zip code similar to Travelocity and Kayak for airline tickets and hotels. Consumers’
pricing would be instantly transparent.

There is no indication that the Obama administration is working
on this.

It is up to consumers to force the issue of price transparency.
It will lead to price competition and decrease the cost of healthcare..

Physicians in some parts of the country have taken the
initiative to encourage real price transparency and price competition.

I do not think we can rely on the government.

The Obama administration’s goal is to not have a healthcare system
with free market competition. He wants a government controlled healthcare
system.

The start of exposing the real cause of healthcare inflation has begun. The billing and reimbursement system is
finally being questioned.

I hope the debate creates an uproar among consumers who are the most
important and most disadvantaged stakeholders in the debate. My hope is consumers will realize they
are pawns in the complex billing and reimbursement system created.

Consumers must also realize they have the power to demand control over their
healthcare dollars and not hope the government will protect them.

The Centers for Medicare and Medicaid
Services finally released its massive database containing what 3,000 hospitals
charge for 100 of the most common medical procedures.

The database compares the hospital
“chargemaster” to the prices Medicare actually paid.

The reimbursement to hospitals is based
on the hospital system’s estimates of the actual hospital costs plus hospital
administrative overhead. These estimates are an error. The calculation should be the actual costs
and not an estimate of the actual cost.

Another important question is how many
hospital administrators in a hospital system get an excessive salary for the
value they add to medical treatment.

Who is worth more, a physician or a
hospital administrator?

In many cases the
reimbursement by Medicare to some hospitals is 10% of the hospital’s billing. In other hospitals the difference is 20-40%.

The payment gap between hospital charges
for procedures and Medicare payments is also stunning. The average difference
between hospital charges for the 100 procedures tracked and what Medicare’s
average actually payment is a difference of 72%.

A good metric is to beware of the man
that quotes average percentages if you want to understand the actual
difference.

The best example I have seen to visualize the variation of these prices
in simple terms is as follows.

Why should healthcare consumers in
America put up with it? Isn’t it the government’s job to protect us from this
abuse and not have a system that encourages it? Obamacare claims to stop the
abuse as it has been going on its merry way to encourage it.

This is not the entire grizzly story.

The average prices by states shows
massive discrepancies. In California, the average hospital charges $101,844 to
treat respiratory infections. In Maryland the average price for the same respiratory
infection is $18,144. The difference is 82% for the same disease in two
different states. The government is the same payer for both states.

New Jersey hospitals bill an average for
$72,084 for "simple pneumonia," while Massachusetts’ hospitals charges
an average of $20,722. Neither of the state’s hospitals receives that much
reimbursement for treating these infections from Medicare. However, New Jersey
hospitals receive more.

Uninsured patients and the indigent
without insurance are getting the shaft. These people will have to pay retail
hospital prices or get sued by the hospital system.

None of the hospital prices are
transparent. A patient cannot even beg the hospital system to get a price.

Many treatments can be administered as
an outpatient. The government pays at least three times more for chemotherapy
in a hospital setting or a hospital outpatient clinic as it would to a freestanding
private outpatient oncology clinic.

What’s the deal? The government doesn’t
trust physicians. It is afraid physicians will overcharge.

What does the government think the
hospital systems are doing?

I have also written about primary care
physicians’ salary being about $100,000- $120,000 a year. Surveys of physician
salaries have shown salaries varying between $100,000 to $600,000 per year. Surgical
subspecialists receive more than primary care physicians.

Let us assume the average physician’s salary
is $300,000 per year. There are approximately 600,000 practicing physicians in
the U.S.

The total physician reimbursement is $180
billion dollars a year in a $2.7 trillion dollar industry. This is less than
10% of the total dollars spent. Even if you doubled physicians’ salaries to
include an overhead of 50% physicians receive 13.2% of the healthcare dollars
spent.

A major question is where is the
remaining 2.5 trillion dollars going?

The healthcare insurance companies take
40% off the top of all care delivered including Medicare and Medicaid and other
government programs. They do all the government administrative services and
hide the fees through deductions that should go to expenses but with the
government’s permission go to direct patient care.

The most important metrics are never
discussed and inaccurately measured.
They are clinical outcomes and quality of procedures performed with
respect to financial outcomes.

The reason this measurement is not done
is because there is no accurate definition or measurement of these metrics.
Clinical outcomes as it relates to cost of care has to be included in the
measurement of quality of care. No one
knows how to do this.

How does all this get fixed?

An easy to use web site should be constructed
using the Travelocity, Expedia or the Orbitz formula.

All hospital and physicians’ prices
should be online. All insurance and government reimbursement should be
published on this web site, plus
insurance premiums and their justifications. The real government overhead
should also be available to consumers.

A government web based educational
program to make consumers smart medical consumers would decrease healthcare
costs immediately.

All of the above would be a good start.

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone

“But today, as doctors and hospitals struggle to make new records
systems work, the clear winners are big companies like Allscripts that lobbied
for that legislation and pushed aside smaller competitors.”

At Allscripts Healthcare
solutions, annual sales have more than doubled from $548 million in 2009 to an
estimated $1.44 billion last year.

“Current and former industry executives say that
big digital records companies like Cerner, Allscripts and Epic Systems of
Verona, Wis., have reaped enormous rewards because of the legislation they
pushed for.”

Unfortunately, many of the
EMR systems bought by large hospital systems and physician practices are not
fully functional. They do not fit the administration’s criteria of meaningful-use
EMRs. These EMRs are requiring additional hospital systems and physicians;
practices outlays of cash to make them fully functional.

“The purported class action
lawsuit says that about 5,000 small group physicians were sold an EMR called
MyWay from 2009 until late last year, when the company stopped supporting the
product.”

“The company was also hit with
a federal shareholder class action securities fraud lawsuit in the Northern
Illinois District last year over allegations that it misled investors about the
performance of its EHR programs.”

The MyWay EMR cost about $40,000
per physician. ThePain Clinic of Northwest Florida claims it was misled by
Allscripts Healthcare Solution. The
Clinic stated that MyWay has “shortcoming
and inherent defects,”

The
complaint says Allscripts was unable to obtain “meaningful use” bonus status
for MyWay because of the problems with the program. The lawsuit claims that

“Allscripts has been unjustly enriched by
retaining the money paid by MyWay purchasers and users without delivering an
EHR software product that performs as it was intended to work,”

These costs are always
passed on to the consumer. Drs. Groopman and Hartzman go on to say,

It is important to note Drs. Groopman and Hartzman’s total
and refreshing frankness.

“We both voted
for President Obama, in part because of his pragmatic approach to problems,
belief in empirical data, and openness to changing his mind when those data
contradict his initial approach to a problem”.

“ We need the
president to applyscientific rigor to fix our
health-care system rather than rely on elegant exercises in wishful thinking.”

Please note that Drs. Groopman and Hartzman said it not
me.

In
a new study The RAND Corp has backed off on its 2005 study earlier this year
and withdrew its estimate of saving to the healthcare system of $81 billion
dollars annually.

In the
RAND Corp’s view, the disappointing performance of health IT to date can be
largely attributed to several factors:

“Sluggish
adoption of health IT systems

Coupled
with the choice of systems that are neither interoperable nor easy to use;

The
failure of health care providers and institutions to reengineer care processes
to reap the full benefits of health IT.

We
believe that the original promise of health IT can be met if the systems are
redesigned to address these flaws by creating more-standardized systems that
are easier to use,

EMR are
truly interoperable,

Afford patients more access to and control
over their health data.

Providers must do their part by reengineering
care processes to take full advantage of efficiencies offered by health IT, in
the context of redesigned payment models that favor value over volume.”

It should not be a blame game.

General Electric sponsored this new RAND study. It is important to note that GE is a major
Allscripts competitor.

There is true value in the EMRs to patient care. However the
focus of the marketing and development is on the wrong customer.

The RAND still does not get it. Perhaps
it does not want to get it.

EMRs should be for the benefit of physicians and their
patients. It must be at a price physicians can afford to pay. It should not be
for the benefit of the government, the healthcare insurance industry and
hospital systems.

It should be a tool to
continually educate physicians and patients. It should not be a tool used by
secondary stakeholders to penalize physicians and patients.

Patients and physicians control My Ideal Electronic Medical
Record. It should be seriously considered to achieve the maximum benefit of EMRs’
potential.

I believe it would be of value to interested readers to go
to this link.

Those articles will
not only describe the problems with EMRs, problems which I have predicted and are
now recognized. These articles will also outline real solutions to having universal adoption of
EMRs.

Everybody knows about the
Obama administration’s tricks and cover-ups. Few know what to do about them. Some know what to do. More and more people are seeing right
through the charades.

In America, unfortunately,
strong vested interest lobbies are effective. I pointed out some of the abuses
of hospital systems lobbies a few weeks ago.

Consumer advocacy
lobbyists do not seem to understand the real issues causing the healthcare
system to be dysfunctional, nor have the money to fight these issues.

Steve Brill’s article in
Time Magazine published hospital retail prices and not the actual prices the
hospital collects. Retail price get the public’s attention. The real issue is
the wholesale prices the government and the healthcare insurance industry pay.
These allowed wholesale prices are also grotesque.

There is a lot of non-transparent
funny business going on behind closed doors with Medicare. It is going to be
accentuated with Obamacare.

This is a very stupid
rule. Sometimes it is the hospital that should be responsible for readmission
because the care was poor, the patient was not ready to be discharged or the
patient had inadequate education about their disease to avoid hospitalization.

The hospital systems’
pressures are to get patients discharged quickly.

My guess is it is the
patient that is responsible for the readmission most of the time.

Many factors could
contribute to a patient’s readmission. They include

Not
following the physician’s post discharge orders.

Not
given appropriate post discharge orders

Not
being taught to become the professor the their disease.

Not participating in adequate follow-up care.
Follow-up care is important but it has become outrageously expensive.

Medicare
has permitted home healthcare services to charge high prices for simple
services and procedures that have little impact on patient education and
avoidance of readmission.

Documentation
by the home healthcare service drives the expensive reimbursement and not the
value of the care.

The real question is
should the hospital system be responsible for patient irresponsibility?

The answer is clearly no.
The bureaucracy’s answer to the problem is that one size fits all.

Hospital systems are aware
of this defect. Hospital administrators and their lobbyists are working hard to
get around the rule.

Some have figured it out.
They are keeping the patients in the emergency room and charging ER fees that
they can collect rather that putting patients in the hospital and generating
charges they cannot collect.

The study
looked at nearly 12,000 discharged patients from Boston Medical Center. Twenty
five percent of the patients discharged from the hospital appeared in the
emergency room in less than 30 days and forty percent of those patients were readmitted
to the hospital.

Hospitals
keeping patients in the ER amounted to a great saving and indeed profit for the
hospital.

Defective
rules and regulations lead to many unintended consequences. No one has tried to
motivate patients to be responsible for not being readmitted to the hospital.

Some
readmissions cannot be avoided. Many readmissions can be avoided.

The main
question would be how to motivate all stakeholders to have incentive to avoid
readmission to the hospital.

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone

Veterans complaining about the VA Hospital System in my last
blog brought on a flurry of negative comments about practicing physicians not
connecting with their Medicare and
commercial insurance patients in the private sector.

The chief complaint is that physicians are not connecting to
their patients or their patients’ illness. I have heard enough stories to
believe it is true.

A 44-year-old male with
private healthcare insurance sent one such complaint to me.

His acute illnesses history was compatible with acute prostatitis.

He needed a new physician because his previous primary care physician
had taken a sabbatical leave.

He called for help in finding a physician to his friends on
Facebook, Twitter and Link In. The consensus was the physician he describes
below.

The physician did multiple tests, several of which I did not
think were necessary, along with a cursory physical examination. The physician
thought the patient had prostatitis and prescribed Cipro for one month. A
follow-up examination was not scheduled.

The last paragraph in the patient’s note to me was,.

By the way, my doctor's office called to let me know the
lab results are in and they are mailing them to me. The doctor told the front
desk person to send me a letter, which I'll get in a day or two. According to
the front desk person, in the letter he says that my labs look good, and that I
need to work on getting my lipids up. Apparently he included a link to a
website that I can learn more about lipids. Pretty great patient care, eh...

This is horrifying to me. The patient will probably do well.
However there is no contact or concern about the patient’s outcome in this
interaction. There was no physician patient relationship formed for a patient
who is looking for a primary care physician.

I would be very upset if this interaction happened to me. I would be more upset if I then receive a bill
for $800 for the visit.

This patient does not know what the bill will be because the
office said it will bill his insurance company.

The evidence of the loss of the Patient-Physician Relationship of delivering medical care did not happen overnight.

A reader Dr. Dale Fuller sent me this commentary. He walks us through the
evolution of the destruction of the Doctor- Patient relationship.

Dr. Fuller’s view is similar to the view I have discussed in this
blog on multiple occasions. I believe it is important to publish his thought in
its entirety.

"Whatever Happened to
the “Doctor- Patient Relationship?”

Dale Fuller M.D.

Lately, I
find myself thinking about this question more and more. I think the first time I heard the term,
“doctor-patient relationship” was back during Harry Truman’s administration,
when there was an effort led by the Democrats to create a National Health
Insurance Program.

“Socialized
Medicine” the opposition cried, and “The end of the doctor patient
relationship! I wasn‘t even a student
in college back then, and in the absence of more information, I saw the
doctor-patient relationship in the context of my experience with the doctor who
looked after me on those rare occasions when I needed to see him,

Dr. T.D.
Jones, who was a very kind man. He was a
small town doctor, and the only doctor in my hometown as well as a good many
other towns around it during World War II.

I kind of
understood the term “socialized medicine” in the context of the then-new
National Health Service being launched in Great Britain.

Truman and
company lost the battle for NHI back then.

The next big
“Socialized Medicine initiative arrived in 1960
“Socialized during the Republican administration of Dwight
Eisenhower.

Senator
Robert Kerr, of Oklahoma and Rep. Wilbur Mills of Arkansas, both Democrats
introduced the Kerr-Mills act, the “Medical Assistance for Aged Act 1960-1965”
(benefiting primarily the elderly on Old Age and Survivors’ Assistance).

Kerr-Mills
was passed in 1960, again over cries that it would destroy the doctor-patient
relationship. But this time the cries
were neither so loud, nor as successful.
By this time I am a newly minted MD, and my awareness of the total
meaning of the term is still mostly intuitive.

During the
administration of Lyndon Johnson, came the Social Security Amendments of 1965,
which brought us Medicare and Medicaid.

When I
entered practice in 1968, Medicare and Medicaid were just getting under way, so
I never experienced what it was like to practice in the absence of the law.

In March of
2010, President Obama signed into law The Patient Protection and Affordable
Care Act, and we are now living through the incremental steps preceding that
law becoming fully in effect in 2014.

The various
legislative initiatives have, to be sure, impacted the doctor-patient
relationship in many ways, as the opponents predicted, but it appears to me
that we have been hearing less and less about that relationship as the years
have passed.

I think it
might just be that the relationship we are discussing may be threatened by a
number of other forces other than the laws described above, but before I
attempt to list those forces, I want to spend a little time setting the stage
to describe just what the doctor-patient might and might not mean.

Goold and
Lipkin, in an article published in 1999 (1) called the doctor-patient
relationship “a keystone of care: the medium in which data are gathered,
diagnoses and plans are made compliance is accomplished, and healing, patient
activation, and support are provided.”

They say that
the medical interview is the major medium of health care, and that more than
82% of diagnoses are made by history alone.

The three
functions of a medical interview are the gathering of information (both through
history and physical examination) developing and maintaining a therapeutic
relationship, and communicating information.

In the eyes
of the law, physicians also have a fiduciary responsibility toward their
patients. Physicians are bound to act in their patients’ interests even when
those interests may conflict with their own.

In that
physicians are often directly involved with events and conditions that are
life-altering for their patients and families, at birth, during severe illness,
healing or death, it can also be said that in being a physician, and providing
health care, doctors are engaging in a moral enterprise.

There was a
time when the unwritten social contract laid out above, simply existed as an
understanding between patients and doctors.

In the early
1940’s the arrival on the scene of what became the Blue Cross and Blue Shield
program, initially serving the employees of the Dallas, Texas Independent
School District began to interpose a third party, the insurance company,
working through the employers, in the social contract that was the Doctor-Patient relationship.

Initially
that interposition was pretty innocuous, with the insurance plan simply paying
the bills of the doctor as they were presented. The phrase, “usual and
customary” arose to define the fees involved that the insurance company paid.
Unusual fees or fees exceeding customary levels became subject to challenge,
requiring justification if they were to be paid.

Over time, a
database of fees that really were usual and customary began to become a better
and better tool to define where the usual kind of fee stopped and the unusual
kind of fee was recognized.

Kerr-Mills,
when it came along, introduced the federal government as a payer, and
relatively soon thereafter, the health care bureaucracy began to grow and
insert itself between doctors and patients to an increasing degree.

Since this
was in the “Pre-Medicare era” the number of patients involved was relatively
small, and so the impact on the doctor patient relationship was still somewhat
limited.

The arrival of Medicare and Medicaid served to
illustrate that the old “camel entering the tent” analogy was beginning to come
true.

Initially,
while the organizations were formed to administer the programs, “usual and
customary” was still the order of the day where payments were concerned, and
the social contract still functioned much as it had always done.

At the
request of the Department of Defense, organized medicine (AMA) created a set of
relative value scales in an attempt to standardize professional fees. The set
of codes was called “Current Procedural Terminology (CPT codes)” (first
introduced in 1966).

The charges
were to be based upon a blend of time required, professional skill involved,
and liability risk.

The compendium
of procedures have grown over the years, the principles remain essentially the
same.

In a fit of
zeal, the Federal Trade Commission inserted itself and accused professional
societies of “price fixing” via the CPT codes.

Settlements
eventually ensued, and money passed from the societies that were sued to the
FTC, and life, after the “nolo contendere pleas’ went on as usual.

The reason
for this was that the societies were not well enough funded to defend their
position vs. the FTC, even though they might have won their cases.

Increasingly
though, as might be expected, the government began to insert itself more and
more into the transaction between doctors and patients, generally, drawing upon
the reality that it was paying, directly or indirectly, for more than 50% of
the care given in the US.

Regulations
and rules have proliferated, respecting what can and cannot be done for
patients who are beneficiaries of federal programs.

Another force
was also becoming more vocal in making statements and policy regarding what
could and could not be done for patients.

This force
began with the passage of the Health Maintenance Act of 1973. This act enabled a vast acceleration of the
whole concept of managed care.

Healthcare
Insurance Companies citing the growing demand for, and cost of medical care to
employers, found a ready market among employers for their “products” to serve
as “benefits” for their employees.

Physicians
and hospitals, fearing that they might be left out of the managed care programs,
made haste to “join” this program or that program, seeking access to the
populations of patients enrolled in the programs by the insurance companies
selling coverage to employers.

The fear was
that exclusive arrangement with insurance companies would eliminate whole
populations of patients from providers who had not “signed up”.

This meant
that the traditional bilateral social contract between doctors and patients
essentially had come to an end of sorts.

Patients’ expectations
were that service and behavior of the doctor they were allowed to see remained
pretty much the same except for a small by important fact.

Those
employees covered by managed care were required to see the doctors who
participated in the program, and to use the hospitals the programs had
agreements with.

Financial
penalties awaited those patients who sought their care “out of plan”, for
whatever reason.

Now patients
and doctors both have someone else “calling the tune” when it comes to the
delivery of healthcare.

Each time the
“plan” purchased by the employer changed, for whatever reason, there could be a
change in the physicians and hospitals available to the patient.

This brings
us to a key element of the doctor-patient relationship. A key element is
continuity of care.

Continuity of
care brings with it an opportunity develop relationships in which doctors and
patients really know and trust one another. This relationship allows physicians
to recognize changes in patients and recognize the early onset of disease.

Neither the physicians’ understanding nor the
patients’ trust cannot be rebuilt immediately between two individuals each year
who are basically strangers to one another.

Doctor of days past, the trusted counselor, often
friend and confidant, is no longer exists.
Now, patients are simply seeing another person in an office. Both
parties are at sea when it comes to knowing what they need to know about one
another to allow the encounter to produce the necessary result within the time
allowed.

Time, like
continuity, is also a vanishing element in the doctor-patient
relationship. Fewer and fewer
practitioners have the time, amidst the pressures of “patient throughput” to
really engage in patients’ needs.

Physicians
must gather and record data, establish a diagnosis, and create a treatment plan
of quality.

The
documentation has to be complete in order to get paid by the government or the
healthcare insurance carrier.

Doctors must also
explain his treatment plan in such a way that they are assured of patients’
compliance with the treatment proposed in the time available to doctors.

As a result
of decreasing reimbursement and increasing overhead the time necessary for
patient education is insufficient. Patients do not understand the significance
of the therapy. The result is a lack of compliance.

Another
problem is that the “third party payers” rather than the patients approves of any
tests and procedures that doctors believe are needed to strengthen the
diagnosis.

The result is
a further erosion of patients trust in the doctor.

The time for
a consultation is short. Tests and procedures are now increasingly used to
substitute for the gathering of data to make the diagnosis.

Tests and
procedure escalate the costs of medical care.

Data
gathering by history and physical examination is time consuming. If a history
and physical examination is properly done it can yield the diagnosis of patients’
problems about 80% of the time.

The
doctor-patient relationship is indeed fading into the past. The third party carriers
and the federal government have, in their zeal to contain cost, pretty much
seen to that.

The reality
is that the destruction of the doctor-patient relationship costs more in the
long run.

The federal government, in its enthusiasm to
make a positive impact on the quality of care patients receive, has mandated
the use of electronic medical records.

The EMR in
its own way have also served to diminish the doctor-patient relationship.

In many
doctors’ offices, the focal point in the room is a computer with data entry.
The keyboard and the screen have almost the full attention of the doctor, who,
without looking at the patient, asks the questions and types the responses.

The patient is lucky if the doctor makes eye
contact with him/her for a brief interval a couple of times during the visit,
thus further diminishing the possibility that trust can be built in the
encounter.

The quality
of the encounter can, in the opinion of various policy makers and consultants,
be measured and changed in the same way that manufacturing processes can be
impacted by applying the principles taught by Deming and others.

Maybe it can,
but it has yet to be demonstrated.
Processes peripheral to the interaction of patient and doctor, may be
made better, but there is little evidence that the same approach can bring back
anything like the doctor patient relationship we used to know."

The three basic goals of Obamacare are
to create an affordable healthcare system with access to care of high quality.

A complicated and complex
bureaucracy that is over regulation will be very difficult to enforce.

It will penalize physicians’
judgment as it tries to decrease reimbursement. It will restrict patients’
access to medical care. It will reduce freedom choice.

Obamacare will not enhance the
Patient Physician Relationships that are so vital to a successful therapeutic
effect.

A healthcare system that places
consumers in control of their healthcare dollars and provides incentives to
consumers to be responsible for their health and healthcare will encourage
physicians to save money and rejuvenate the Physician Patient Relationship for
improved therapeutic outcome at an affordable cost.

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone

Although
we know much of this, this is an excellent overview of healthcare costs.

Steve

All Americans ought to
understand the distortions hospital system pricing creates. The government
ought to make hospital pricing transparent to everyone..

The government should include
the hospital system’s retail price, wholesale price and actual cost for an item
or service.

Then, consumers can choose
the hospital system to go to.

Policy makers continually criticize
this ideal saying that illnesses are sudden and patients are not in a position
to choose a hospital system or negotiate price.

If the hospital system is
compelled to compete on price the price will be the same as the competitive
price when the patient gets sick. If one hospital is much higher than the next
hospital the patient will know this before hand.

Hospital system charges
are actually higher than they appear. Most hospital systems are non-profit
organizations. The hospital systems do not pay taxes.

As seen in Steven Brill’s
article oncology charges are extremely high.

One oncologist wrote to me
and said he could administer the same therapy in his office for one-tenth the hospital
cost.

However, neither the government nor the healthcare insurance industry
would reimburse him for the office procedure. It is the same procedure he performs
in the hospital.

Doesn’t that seem strange? What is going on?

Steven Brill discovered
that it is almost impossible to find out what hospital systems are charging.

The same opacity is true
for pharmaceutical charges. The
pharmaceutical charges are further inflated by multiple middlemen involved in
drug distribution.

This has been less true
for drugs since Internet Drug stores publish drug prices.

However, since the patients’
physicians prescribed the drug patients are hesitate to use substitute drugs.
The patients’ attitude is that the healthcare insurance company will pay for
the drug less the copay.

Therefore the patients are not interested in looking
up the difference in price or the options for substitution.

This is the reason consumers need skin in the game.

The result of consumer apathy is an increase
in healthcare insurance premiums.

Steven Brill covers the
grotesqueness of retail hospital system charges. He also points out the amount
Medicare reimburses for the grossly inflated charge.

The consumers without
insurance are the consumers that get stuck with the retail charges. Insurer consumers recieve a large discount. The uninsured
consumers are least likely to be able to afford these charges.

In some cases Medicare
reimbursement is less than 20% of the hospital retail charge. Steven Brill
points out that at this time Medicare reimbursement to hospitals is still 10
times its actual costs.

The article “Bitter Pill” is
excellent. It covers many categories of hospital system abuse by the use of
case studies.

The facts are
overwhelming. I am going to try to
categorize these facts in my next blogs. The abuses will be easier to remember.

Consumers must be educated.
The hope is consumers can be activated by education. Only a consumer driven
healthcare system can drive the abuse out of the healthcare system.

Then,
Americans will have an affordable healthcare system.

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.

Nevertheless on January 1st CMS proudly announced that
it has nearly doubled the number of ACO programs in the country by adding 106
new ACOs to the existing 148 programs for a total of 254 programs to date.

“An insurer, or insurance carrier, is a company selling the
insurance; the insured, or policyholder, is the person or entity buying the
insurance policy. The amount to be charged for a certain amount of insurance
coverage is called the premium.

Risk management is far
from an exact science. Risk management depends on a large number of people
paying premiums who are not at risk for disease.

Obamacare’s goal is to
have all the low risk consumers pay for the higher risk consumers.

However, President Obama
has provided low risk consumers an out. The penalty for not participating is
modest compare to the cost of the insurance. If a low risk consumer gets sick
he can immediately join the health insurance exchange program without
restrictions.

The increased cost of
illness is compounded when a large number of patients have chronic diseases.

A contributing factor to
developing chronic disease is obesity.

America has a national
obesity epidemic.

Patients with Diabetes
Mellitus are vulnerable to multiple diseases such as hypertension,
hyperlipidemia, kidney disease, eye disease and vascular disease.

Each might be at a
different stage of progression. The risk for costly complications is different
for each at each stage of disease progression.

The diabetic might or
might not adhere to the treatment regime outlined. It is difficult to risk
weight these patients. It is risky to take the responsibility for the medical
care outcomes for these patients.

In reality the principle
risk managers are consumers.

Healthcare policy
experts have not practiced medicine. They either do not understand these risks
or they want to place the risk with physicians and hospital systems and provide
undervalued reward.

Many medical outcomes are
dependent on patient responsibility for managing their own risk. Patients must
participate in their own care to receive maximum benefit and the best medical outcomes.

1. ACOs
do not empower consumers to be responsible for their own medical care.
Healthcare should be consumer driven with consumers controlling their healthcare
dollars. They will then make informed choices about their care and insurance
coverage.

In a systems of ACOs consumers do
not play a role in stimulating completion. Consumers are passive recipients of
treatment from an assigned ACO.

4. Most physicians are reluctant
to assume accountability for patient outcomes. Physicians recognize that
most medical outcomes are directly under consumers behavioral control.

5. ACOs structure does not include consumers’
incentive to be responsible or accountable for their own medical care.

ACOs undermine any attempt to create a truly
accountable healthcare system that can drive down medical costs.

6. ACOs do not encourage provider
accountability. ACO’s shared savings incentive
does not seem to be adequate for the risk assumption.

Providers will continue to
be paid for each service they perform until the government provided
funds run out for that ACO.

7. There are also grave uncertainties and
practical complications of distributing government funds and savings if any
between the hospital system and physicians on the hospital systems staff.

8. ACOs create an
unfair competitive advantage for large organizations that are hospital system centric.
Eligibility requirements are vague and ambiguous. The eligibility
requirements suggest that larger organizations have an unspoken
eligibility advantage.

9. This is the reason
hospital systems are trying to form ACOs. Hospital systems think they will make
money. I believe hospital systems will lose money. The government will have to
supplement payment for hospital systems to stay afloat.

10. When hospital systems lose
money they will fight with their staff physicians over the distribution of
government reimbursement.

The cost of hospital services will then
skyrocket further. Consumers will be the losers.

11. Groups of independent
practitioners as well as other types of small and mid-sized practices may
lack the infrastructure, information technology facilities, or other resources
needed to qualify for ACO eligibility.

12. They will be forced to join hospital systems.
Hospital systems have a long history of taking advantage of physicians
skills and intellectual property.

Tension between hospital systems and staff
physicians will be created. Hospital systems’ ACOs will crumble. The cost of
medical care will continue to increase further.

These are just a few of the reasons ACO’s will fail.

No matter how hard CMS tries to change the narrative
these are some of the reasons explaining the lack of hospital and physician participation
to this point.

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.

About once a week I have an in-depth conversation with my
son Brad. In my view his perception of the world is more accurate than most. In
his younger days I did most of the teaching and he did most of the listening.

Today, I do most of the listening and he does most of the
teaching. This morning he said something profound. We were talking about large
corporations business models. He said most corporations do not know what
business they are in.

He is right. As technologies change business model must
change. If the business model does not change the corporation cannot survive.

The healthcare industry and the medical care industry
(physicians and hospital systems) must re-examine their premises and change
their business model.

President Obama is trying to change the business model
with Obamacare. In reality he is not changing the old business model at all. He
is expanding the old business model that has failed.

He is also making the business model more complicated. He
is building an elaborate and expensive structure whose goal is to decrease
costs. It will cause the system to fail faster.

Obamacare is adding a more punitive and restrictive
element to healthcare delivery rather that a more innovative and rewarding
element to both the patients and physicians.

It is not designed to promote health; it is designed to
cut costs by limiting access to care, rationing care and decreasing freedom of
choice.

Obamacare pays lip service to preventive care. Preventive
care will be largely ineffective because of the reimbursement metrics and lack
of incentives provided to consumers.
Consumers must be incentive driven.

There are many examples of long time successful
corporations that could not change their business model fast enough. These
companies were muscle bound either because of a lack of vision, a lack of
leadership, multiple committee meetings and too much decentralization of an
ever-expanding bureaucracy.

Eastman Kodak is a perfect example. It was the premier film,
film processing and photography paper manufacturer in the world.

Kodak did not
recognize that it was in the imaging
business. The technology of digital photography put Kodak out of business
because Kodak could not change its business model fast enough.

Royal Typewriter Company viewed itself as a typewriter
manufacturer. As soon as IBM developed the innovative Selectric typewriter
Royal should have figured it out.

Royal should have developed a faster and more innovative
typewriter. Royal also should have jumped on the development of a typewriter
that would store the typed data. Instead
it was more of the same old.

It did not take long for consumers to drive the
typewriter companies out of business. Word
processing on computers made typing documents easier and more useful.

The railroad business did not have the vision to understand
it was in the transportation business. Airplanes, eighteen-wheelers and
Greyhound buses almost drove the railroads out of business. Railroads did not realize
that consumers wanted a better product. A product that is faster and cheaper.

Railroads have only partially recovered.

Consumers drive innovation. If a new great product is
introduced to consumers, the new product can take off at the expense of the
legacy product.

Just think about ITunes and the music industry, the
IPHONE and the legacy landline telephone industry and the IPAD and the desktop
computer industry.

Amazon has dis-intermediated the Book Publishing industry
with its Kindle and wireless downloading of books.

The opportunity in healthcare is similar. However
Obamacare is driving the country in the opposite direction away from a consumer
driven industry into a government controlled, bureaucratically dictated
decision making industry.

The business model
of 2020 should look like this.

Instead it is going to look like the slide below under Obamacare. The
healthcare industry is going to collapse under its own structure.

The
effective future business model will put consumers in charge of their
healthcare dollars and provide consumers with financial incentives to stay
healthy.

It
will decrease the healthcare industry’s control of the healthcare system.
Consumers will have control of their own first dollar coverage.

Consumers
will drive the healthcare system to produce the best medical product. They will
seek high quality care at the lowest price.

Physicians
and hospital systems will want to produce the best product at the lowest prices
so they can attract patients.

Only
a consumer driven healthcare system will drive the technologies of efficiency
into the healthcare system.

Remember,
without patients or physicians there would not be a healthcare system.

President
Obama is blinded by his ideology. His healthcare policy goal is to eventually
have a single party payer system. Medical care will be commoditized with
treatment decisions made by the central government.

It
is a charade that his health insurance exchanges will lead to affordable
private insurance. It is misguided to believe that a non-elected central
committee (IPAB) will be tolerated to make treatment decisions for the
population.

The
larger pretense is that President Obama is building an inexpensive bureaucracy.
Last week he again stated that government overhead for Medicare and Medicaid is
very low. He again declared that the overhead expense is only 2½ percent.

It
cost two and one half percent for the central government to outsource administrative
services to the healthcare insurance industry. The healthcare insurance
industry, in turn, charges the government 18-40% to administer the programs.

Everyone
knows most everything government run is inefficient. President Obama is
enlarging the scope of government in all areas at a time when government is too
large and inefficient. The government’s income is $1 trillion dollars less than
its expenses per year since he has been President.

President
Obama thinks if he spends enough money he will spend his way out off the jam.

President
Obama believes one way to become more efficient is to gather more data. He can
then figure out which hospital systems and physicians are inefficient and
penalize them.

This
philosophy has two potential pitfalls. If the data is faulty the conclusions
are wrong. The second pitfall is that penalties do not encourage cooperation
and meaningful improvements.

One problem is that quality is not clearly
defined and is sometime false. The government must reexamine its premises.

Most hospitals and health systems have lots of
data that might improve outcomes and cut waste.

The
problem is getting that data, which is often unstructured, into a format that
allows clinicians to make decisions faster and in a more coordinated fashion.

All
of the innovation is happening without input from physicians. It is being done
to decrease the cost of the hospitals. One thought would be to get rid of a few
excess salaried, $750,000 a year hospital administrators and $2,000,0000 plus
healthcare insurance company administrators which would go a long way to reduce
the cost of healthcare coverage.

Instead
the government is looking to penalize physicians. Physicians are the providers
that deliver medical care.

There
is software being developed that deals with real time processing of clinical
data. The software can communicate those data to networked physicians instantly
and help physicians deliver more timely care.

Many
hospital systems are trying to install these real time systems. Unfortunately,
many hospital administrators do not understand its power as a teaching tool to
increase the efficiency and effectiveness of medical care.

The hospital systems’ only interest is in the
financial result and the question of whether the huge investment is worth the
capital expenditure.

Most
physicians do not have an EMR and only 7% of physicians have a fully
functioning EMR.

In
the monograph from “Pathways to Data Analytics” two things were very apparent. It
looks like the healthcare insurance industry controls the committee and its
plans is to continue to control the healthcare dollars and hope to control the
healthcare data.

“We’re moving from an
individual practitioner cottage industry to a team-based process now . . .. [Medical
care] is beyond the capacity of any one individual to be expert enough to do
that. So we have to do it in a team.”

A team requires information. The changing dynamics of healthcare
spending and reimbursements also require data to navigate.

“Our analytics are not just for finance, which traditionally is
what hospitals invested in,” says St. Luke’s Chief Quality Officer Donna Sabol
, MSN, RN. “When you look at how [hospital] payment is changing [to] a value-based
equation, you have to have good analytics for finance and for quality.”

Absent from the report is the patient and his/her responsibility
to the therapeutic unit. Until some policy maker understands the role of
patients to the therapeutic unit they will get nowhere in improving the
healthcare system.

A glaring example is the money spent by hospital systems to
improve the discharge process to avoid re-hospitalization within the 30 days
post discharge.

Obamacare has instituted the rule November1,2012 that if a
patient is re-hospitalized within 30 days of the initial hospitalization the
hospital system will not get paid.

I can think of 5 ways hospital systems can get around this rule
without suffering the penalty.

None-the-less the hospital systems are buying software to study
and automate the process to avoid re-hospitalization using its clinical data in
real time.

The Seton Hospital System in Austin Texas
might have figured it partially out.

It started what it calls an extensivist
program. It is acting as an extension of its physicians care to help avoid re-hospitalization
and use the best data it can collect.

"It's taking the whole universe of
information we have and cutting out what's extraneous and giving clinicians the
information they need to make decisions."

Ryan Leslie is vice
president of analytics and health economics at Seton Healthcare system. He is taking
unstructured clinical information and connecting that with billing or
administrative information and social demographic information.

He says, "you start connecting all those things
together and you get a more complete picture of the patient as a person, rather
than as a recipient of a bill," he says. "That's been the exciting
thing recently. You realize that a patients' success or failure may not have to
do with the care plan details or the clinical attributes of the patient as much
as the social attributes."

Physicians
outside the hospital work with a team of social workers, nurses, and others to
visit patient homes and figure out what's keeping a patient from effectively
following treatment protocols that will likely keep them out of the hospital.

The software
helps determine, based on a host of combined data, which patients are most
likely to be re-hospitalized within 30 days. Targeting the patients is like
looking into a crystal ball. The hospital system cannot afford to service all
the patients with congestive heart failure. The program is in its early stages.
If successful the plan is to expand it to diabetes and other chronic diseases.

This will
happen well beyond November 2012 and January 1,2014. This hospital system
finally realized that it can and must be an extension of its physicians’ care
and not a competitor for patient care.

Missing is the
patients responsibility and incentive in not being readmitted to the hospital.
This can only be accomplished when consumers not only have a desire to be
healthy they have a financial interest to stay healthy.

This can be
accomplished in a consumer driven healthcare system where the patients are responsible
for their health and own their healthcare dollars. The easiest way to get there
is using my ideal medical savings accounts.

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone